A 46-Year-Old Woman Comes to the Physician Because of a 3-Day

A 46-year-old woman comes to the physician because of a 3-day history of diarrhea, moderate abdominal pain, and weakness. Her symptoms began on the return flight from a 2-week yoga retreat in India, where she stayed at a resort. She was mildly nauseous as she boarded the flight, and diarrhea followed immediately after eating the in-flight meal. Since then, she has had up to five watery stools daily. She has a 1-year history of gastroesophageal reflux disease and is allergic to shellfish. Her only medication is ranitidine. She appears lethargic. Her temperature is 37.0°C (98.6°F) , pulse is 70/min, and blood pressure is 115/72 mm Hg. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are hyperactive. Which of the following is the most likely pathogen involved in producing this patient's gastrointestinal symptoms?

A) Bacterial endotoxin
B) Cholera-like enterotoxin
C) Intestinal mucosal invasion
D) Shiga-like toxin
E) "Stacked-brick" intestinal adhesion